Asthma vs. COPD: How to Tell the Difference

If you constantly suffer from shortness of breath, wheezing or bouts of coughing, you should get tested for either asthma or Chronic Obstructive Pulmonary Disease, better known as COPD. The two diseases have many similarities – both involve the airways and cause airflow limitation, but there is one significant difference. According to Dr. Adnan Majid in the Division of Pulmonary Medicine at Beth Israel Deaconess Medical Center, “in asthma, the airflow is reversible – while in COPD, it is not fully reversible.”

What is COPD?:

Chronic Obstructive Pulmonary Disease is characterized by chronic airway obstruction usually caused by inflammation and damage to airways and/or lung parenchyma. It usually appears in older adults who smoke or have smoked, but some patients may have other exposures such as biomass fuel use, fumes, organic, and inorganic dusts. COPD is divided into two groups: chronic bronchitis and emphysema, which cause chronic cough, sputum production, shortness of breath and wheezing. With COPD, lung function slows airflow obstruction that cannot be completely reversed and chronic symptoms get worse over time, which may be debilitating.

What is Asthma?:

Asthma is a chronic inflammatory condition of the airways, characterized by airway hyper reactivity and recurrent episodes of bronchospasm, which are reversible. Asthma presents with similar symptoms as COPD: cough, wheezing, and shortness of breath. This condition can be present in childhood and adulthood, and while some children may experience spontaneous remission, adults are less likely to experience this. Symptoms can be worsened by certain triggers (dust mites, mold, animal dander or irritants) and avoiding them is key for maximal symptom control. Unlike COPD, some lung function is reversible and episodes can be controlled with medication and by avoiding any triggers. However, while symptoms of asthma may seem to disappear over time, spontaneous remission is infrequent.

Dr. Majid says the severity of the symptoms depends on the severity of the disease. “We cannot say one is worse than the other.” He also points out that a patient might have both asthma and COPD. For example: if a patient already has asthma and decides to smoke, he or she might develop COPD. He says it is important to highlight that most cases of COPD are preventable.

Detecting the Diseases:

Both COPD and asthma require a full Pulmonary Function Test (PFT) that includes spirometry, lung volume, and diffusion capacity. However, asthma may require additional testing using spirometry with a bronchodilator or a bronchoprovocation challenge test.

Treating COPD & Asthma:

There is no cure for either COPD or asthma, but the diseases can be managed. “With medication, you can control symptoms, prevent acute exacerbations and prevent the progression of the disease,” says Dr. Majid. If COPD is caught early enough, smoking cessation and treatment with medication will decrease the progression. In asthma-sufferers, the use of appropriate medications (inhaled corticosteroids alone or in combination with short-acting and long-acting bronchodilators) and education about the triggers can decrease the frequency and intensity of symptoms, improve lung function, normal daily activities and quality of life.

Beth Israel Deaconess Medical Center:

Beth Israel Deaconess Medical Center is one of the leading institutions in the northeast, providing therapies for both diseases. For severe COPD patients, the multidisciplinary COPD/Emphysema clinic offers a variety of treatments, including novel investigational therapies, such as endoscopic lung volume reduction.

For patients with severe asthma, the approach is also multidisciplinary and includes evaluation of patients by an Allergist, Pulmonologist, and Interventional Pulmonologist.

BIDMC is one of the few centers in the northeast offering a novel and minimally invasive procedure, bronchial thermoplasty, for the treatment of patients with severe, persistent asthma who remains refractory to maximal medical therapy.